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Hemodynamic effects of fluid loading in acute massive pulmonary embolism

Mercat, Alain MD; Diehl, Jean-Luc MD; Meyer, Guy MD; Teboul, Jean-Louis MD, PhD; Sors, Herve MD

Clinical Investigations

Objective: To assess the hemodynamic effects of fluid loading in patients with acute circulatory failure caused by acute massive pulmonary embolism (AMPE).

Design: Prospective study.

Setting: Respiratory critical care unit of a university hospital.

Patients: Thirteen patients free of previous cardiopulmonary disease with angiographically proven AMPE (Miller index = 24 +/- 1), with acute circulatory failure defined by a cardiac index (CI) lower than 2.5 L/min/m2.

Intervention: Infusion of 500 mL of dextran 40 over 20 mins.

Measurements and Main Results: Fluid loading induced a substantial increase in right atrial pressure from 9 +/- 1 mm Hg to 17 +/- 1 mm Hg and in right ventricular end-diastolic volume index from 123 +/- 14 mL/m2 to 150 +/- 11 mL/m2 (p < .05 for both comparisons). The increase in right ventricular preload was associated with an increase in CI from 1.6 +/- 0.1 to 2.0 +/- 0.1 L/min/m2 (p < .05), whereas right ventricular ejection fraction (15 +/- 3% at baseline vs. 16 +/- 3% after fluid loading) and total pulmonary vascular resistance index (1689 +/- 187 dyne[center dot]sec/cm5 [center dot]m2 at baseline vs. 1492 +/- 166 dyne[center dot]sec/cm (5) [center dot]m2 after fluid loading) remained unchanged. The increase in CI induced by fluid loading was inversely correlated to baseline right ventricular end-diastolic volume index (r = -.89; p < .05).

Conclusions: These results suggest that fluid loading can improve hemodynamic status in patients with acute circulatory failure caused by AMPE. (Crit Care Med 1999; 27:540-544)

From the Respiratory Critical Care Unit, Hopital Laennec, Universite Paris V, France.

(Drs. Diehl, Meyer, and Sors); and the Medical ICU, Hopital de Bicetre, Universite Paris XI, France (Drs. Mercat and Teboul).

This study was promoted by the Direction de la Recherche Clinique de I'Assistance Publique-Hopitaux de Paris (projet P 940314).

Address requests for reprints to: Dr. Alain Mercat, Service de Reanimation Medicale. Hopital de Bicetre, 78, rue du General Leclerc, 94275 Le Kremlin Bicetre, France.

© 1999 Lippincott Williams & Wilkins, Inc.